Related Experiment Video
Updated: Dec 22, 2025
Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
Published on: August 30, 2018
Impact of expanding a paediatric OPAT programme with an antimicrobial stewardship intervention
Julie Huynh1,2, Kate A Hodgson1,3,4,5, Suzanne Boyce1,6,7
1Hospital-in-the-Home Department, The Royal Children's Hospital, Parkville, Victoria, Australia.
Insights
Outpatient parenteral antimicrobial therapy (OPAT) expansion maintained clinical outcomes. An antimicrobial stewardship (AMS) intervention improved antibiotic prescribing, reducing inappropriately long durations and broad-spectrum use.
Area of Science:
- Pediatric Infectious Diseases
- Antimicrobial Stewardship
- Health Services Research
Background:
- Outpatient parenteral antimicrobial therapy (OPAT) is expanding, increasing patient visibility risks and potential for suboptimal care.
- Effective management of OPAT is crucial to ensure patient safety and optimal treatment outcomes.
Purpose of the Study:
- To compare clinical outcomes before and after OPAT program expansion.
- To evaluate the impact of an OPAT-specific antimicrobial stewardship (AMS) intervention on antibiotic prescribing practices.
Main Methods:
- A prospective longitudinal study was conducted over two 12-month periods (pre- and post-expansion).
- The study involved a Hospital-in-the-Home (HITH) program, comparing outcomes with and without an AMS intervention (OPAT-specific guidelines and active prescription review).
Main Results:
- OPAT program capacity doubled, with a proportional increase in patient episodes, including vulnerable populations.
- Successful OPAT completion rates remained high (98%) in both periods.
- OPAT-related complications were low and did not significantly increase with expansion.
- The AMS intervention led to a reduction in inappropriately long antibiotic durations (10% to 6%) and median days on broad-spectrum antibiotics (11 to 8 days).
- Overall appropriate antibiotic prescribing remained high (71% to 76%).
Conclusions:
- Substantial expansion of an OPAT program can be achieved while maintaining clinical outcomes.
- A modest AMS intervention effectively reduced certain aspects of inappropriate antibiotic prescribing during OPAT expansion.
- Further optimization of AMS strategies may be needed to address all aspects of inappropriate antibiotic use in OPAT.
Background:
As treatment out of hospital with outpatient parenteral antimicrobial therapy (OPAT) increases, so too does the risk for patients of being less visible, with potential for suboptimal care.
Objectives:
We aimed to compare pre-expansion and post-expansion (1) successful completion, complications and (2) the impact of an OPAT-specific antimicrobial stewardship (AMS) intervention to mitigate inappropriate antibiotic prescribing.
Design:
A prospective longitudinal study during two consecutive 12-month periods: period A (1 August 2012 to 31 July 2013) and period B (1 August 2013 to 31 July 2014).
Setting:
The Hospital-in-the-Home (HITH) programme at The Royal Children's Hospital Melbourne.
Participants:
All patients who received OPAT during the study period.
Interventions:
Between the two periods, the programme expanded from 16 to 32 patients/day. To coincide with this, a combined AMS intervention was introduced: (1) OPAT-specific guidelines and (2) active review of OPAT prescriptions and input by Paediatric Infectious Diseases.
Main Outcomes:
Successful completion of OPAT, OPAT-related complications, readmission, length of stay and antibiotic appropriateness.
Results:
Over 2 years, 646 patients (47% female, median age 7 years) were treated via OPAT for 754 episodes. Patient episodes increased from 254 in period A to 500 in period B, with proportional increases in infants under 1 month and immunocompromised patients. OPAT was successfully completed in 245/251 (98%) versus 473/482 (98%) (OR 1.8, 95% CI 0.7 to 4.5, p=0.3). OPAT-related complications remained low: intravenous catheter-associated complications 16/138 (12%) versus 41/414 (10%), and antibiotic-associated complications 0/254 (0%) versus 2/500 (0.4%). Despite the increase in activity, with the AMS intervention, overall appropriate antibiotic prescribing remained high: 71% versus 76%. Inappropriately long durations reduced from 30/312 (10%) to 37/617 (6%) (OR 0.6, 95% CI 0.4 to 0.99, p=0.04), and median number of days on broad-spectrum antibiotics from 11 (IQR 8-24.5) to 8 (IQR 5-11).
Conclusion:
During a period of substantial expansion, we maintained clinical outcomes. A modest AMS intervention reduced some but not all aspects of inappropriate antibiotic prescribing.
More Related Videos
03:22Author Spotlight: Advancing Pathogen Detection and Disease Assessment in Real-Time Using M-ROSE
Published on: March 1, 2024
09:26Antibiotic Efficacy Testing in an Ex vivo Model of Pseudomonas aeruginosa and Staphylococcus aureus Biofilms in the Cystic Fibrosis Lung
Published on: January 22, 2021
Related Concept Videos
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
01:28Antimicrobial Effectiveness
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
01:30Development of Antibiotic Resistance
00:57Antibiotic Selection
01:23Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption